Erika Ballard

Individual provider Active NPI General Practice Registered Nurse · Villa Rica, GA

NPI 1194476655 · NPPES record last updated Jan 15, 2022

Key facts

NPI
1194476655
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Registered Nurse 163WG0000X
License
RN25167 (GA)
Practice address
220 Wentworth Cir
Villa Rica, GA 30180-7229
Phone
(267) 666-4753
NPI assigned
Jan 15, 2022
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
RN25167GAMDGeneral Practice Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Ez Go Labs LLC Current
since Feb 27, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X RN25167 GA Yes

Addresses

Primary practice location

220 Wentworth Cir
Villa Rica, GA 30180-7229

Mailing address

220 Wentworth Cir
Villa Rica, GA 30180-7229

Other providers in Villa Rica, GA

All providers in Villa Rica, GA · General Practice Registered Nurse in Georgia

Sources for this page

Verify at the official NPI Registry.